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Chap 6 - Iontophoresis
Chap 6 - Iontophoresis
Iontophoreis
Introduction of Ions Into The Body Using Direct Electrical Current Transports Ions Across A Membrane Or Into a Tissue It is a Painless, Sterile, Noninvasive Technique Demonstrated To Have A Positive Effect On The Healing Process
Iontophoresis vs Phonophoresis
Both Techniques Deliver Chemicals To Biologic Tissues Phonophoresis Uses Acoustic Energy (Ultrasound) To Drive Molecules Into Tissues Iontophoresis Uses Electrical Current To Transport Ions Into Tissues
Transdermal iontophoresis delivers medication at a constant rate so that the effective plasma concentration remains within a therapeutic window for an extended period of time.
Therapeutic window - the plasma concentrations of a drug which should fall between a minimum concentration necessary for a therapeutic effect and the maximum effective concentration above which adverse effects may possibly occur.
Iontophoresis appears to overcome the resistive properties of the skin to charged ion Iontophoresis decreases absorption lag time while increasing delivery rate when compare with passive skin application Iontophoresis provides both a spiked and sustained release of a drug reducing the possibility of developing a tolerance to drug
The concentration of the ion The pH of the solution Molecular size of the solute Current density Duration of the treatment
Concentrated in a specific area Does not have to be absorbed within the GI tract Safer than administering a drug through injection
Highest concentration of electrons Repels negatively charged ions Attracts positively charged ions Accumulation of negatively charged ions in a small area creates an acidic reaction
Lower concentration of electrons Repels positively charged ions Attracts negatively charged ions Accumulation of positively charged ions in a small area creates an alkaline reaction
Difference in current density between the active and inactive electrodes establishes a gradient of potential difference which produces ion migration within the electrical field
Active
electrode- the one being used to drive the ion into the tissue
the size of the electrode will decrease current density under that electrode.
reaction (+ions) is more likely to produce tissue damage than acidic reaction(ions) Thus negative electrode should be larger (2x) to reduce current density.
The quantity of ions transferred into the tissues through iontophoresis is directly proportional to
Current density at the active electrode Duration of the current flow Concentration of ions in solution
Once the ions pass through skin they recombine with existing ions and free radicals in the blood thus forming the necessary new compounds for favorable therapeutic interactions
Iontophoresis Techniques
Iontophoresis Generators
Iontophoresis Generator
Intensity control
1
to 5 mA Constant voltage output that adjusts to normal variations in tissue impedance thus reducing the likelihood of burns Automatic shutdown if skin impedance reduces to preset limit
Iontophoresis Generator
Adjustable Timer
Up
to 25 min
Iontophoresis Generator
Lead wires
Active
Current Intensity
Low amperage currents appear to be more effective as a driving force than currents with higher intensities Higher intensity currents tend to reduce effective penetration into the tissues Recommended current amplitudes used for iontophoresis range between 3-5 mA
Current Intensity
Increase intensity slowly until patient reports tingling or prickly sensation If pain or a burning sensation occur intensity is too great and should be decreased When terminating treatment intensity should be slowly decreased to zero before electrodes are disconnected
Current Intensity
Maximum current intensity should be determined by size of the active electrode Current amplitude usually set so that current density falls between 0.1-0.5 mA/cm2 of the active electrode surface
Treatment Duration
Treatment duration ranges between 1020 minutes with 15 minutes being an average Patient should be comfortable with no reported or visible signs of pain or burning Check skin every 3-5 minutes looking for signs of skin irritation Decrease intensity during treatment to accommodate decrease in skin
Traditional Electrodes
Older electrodes made of tin, copper, lead, aluminum, or platinum backed by rubber Completely covered by a sponge, towel, or gauze which contacts skin Absorbent material is soaked with ionized solution Ion ointment should be rubbed into the skin and covered by some absorbent
Commercial Electrodes
Sold with most iontophoresis systems Electrodes have a small chamber covered by a semipermiable membrane into which ionized solution may be injected The electrode self adheres to the skin
Electrode Preparation
To ensure maximum contact of electrodes skin should be shaved and cleaned prior to attachment of the electrodes Do not excessively abrade skin during cleaning since damaged skin has lowered resistance to current and a burn
Electrode Preparation
Electrode Preparation
Attach self-adhering active electrode to skin Inject ionized solution into the chamber
Electrode Preparation
Attach self-adhering active electrode to skin Inject ionized solution into the chamber Attach self-adhering inactive electrode to the skin and attach lead wires from generator to each
Electrode Placement
Size and shape of electrodes can cause variation in current density (smaller = higher density) Electrodes should be separated by at least the diameter of active electrode
Wider separation minimizes superficial current density decreasing chance for burns
Produce an acidic reaction through the formation of hydrochloric acid Produce softening of the tissues by decreasing protein density-useful in treating scars or adhesions Some negative ions can also produce an analgesic effect (salicylates)
Produce an alkaline reaction with the formation of sodium hydroxide Produce hardening of the tissues by increasing protein density
Inflammation
Edema
Spasm
Scar Tissue
Analgesia
Treatment Precautions
Problems which might potentially arise from treating a patient using iontophoresis may for the most part be avoided if the athletic trainer
Has a good understanding of the existing condition which is to be treated Uses the most appropriate ions to accomplish the treatment goal Uses appropriate treatment parameters and equipment set-up
Most common problem is a chemical burn which occurs as a result of direct current itself and not because of the ion being used
Continuous direct current creates migration of ions which alters the normal pH of the skin Chemical burns typically result from accumulation of sodium hydroxide at cathode Alkaline reaction causes sclerolysis of local tissues Decreasing current density by increasing size
Thermal burns may occur due to high resistance to current flow created by poor contact of the electrodes with the skin
Electrodes are not moist enough Wrinkles in the gauze or paper towels impregnated with the ionic solution Space between the skin and electrode around the perimeter of the electrode Body weight resting on top of electrode